Heart Disease Requires Many Drugs

Q--My father has congestive heart failure and seems to need many drugs. I am confused by them. Why are so many drugs used to treat one illness?

A--Your father could be suffering from one (or more) of several specific conditions which can be present in congestive heart failure (CHF).

Each of the conditions may need treatment with one (or more) different medicines. All drugs prescribed for CHF are aimed at trying to correct insufficiences in the heart`s pumping action. Also, if your father has been ill for a long while, his condition may have changed from time to time, which could have required changes in one or more of his medications.

To try to answer your question more fully, let`s briefly discuss the heart, CHF and some medications frequently used to treat it.

The heart not only acts as a pump which feeds the body`s cells but also helps other organs eliminate certain unwanted fluids (I mainly refer to excess water).

Certain types of CHF can be caused when our kidneys--for whatever reason

--cannot eliminate enough water. Such water retention is called edema

(which often occurs below the knees). In those cases, the heart can be seriously overworked as it tries to help the kidneys relieve fluid congestion. Diuretics often are prescribed in treating patients suffering such conditions. Diuretics promote water excretion, which, in turn, eases demand on the heart. There are different classes of diuretics, each with various actions. It is possible that your father may have taken hydrochlorothiazide, bumetanide, triamterene or others from more than one class as his physician endeavored to develop the best course of therapy for him.

Another group of drugs is prescribed in treating a CHF condition that occurs when something is wrong with the heart`s muscle itself. These are the cardiac glycosides, which have been used for more than 200 years. Digoxin probably is the most widely known of that group, but many people still call drugs in this group ``digitalis.``

Inotropic agents are relatively new medications that also specifically help to improve the action of the heart muscle. Their therapeutic actions differ from digoxin. Amerinone, milrinone and enoximone are among products in that category and may have been prescribed for your father.

Vasodilator drugs are prescribed to cause blood vessels to expand when there is need for increased blood flow. In this group there are drugs which cause vessel expansion in a few selected parts of the body and others which act on virtually every blood vessel. So, your father might take one type of these at some point, and another type as his illness changes.

Among vasodilators that he may have consumed are: hydralazine, nitroglycerin preparations, prazosin and captopril. There may have been great need for quite a number of drugs, with a wide variety of action to help your father.

Q--I`ve heard of colitis of the large intestine, but can the disease also occur only in the rectum?

A--Ulcerative colitis is an inflammatory disease of the inner lining of the large intestine, or colon. Ulcerative proctitis and proctosigmoiditis are similar inflammations of the rectum and of the final curve of the colon leading to the rectum. The symptoms of these two conditions include rectal bleeding and mucus in the stool.

Medical experts disagree on the nature of proctitis and proctosigmoiditis. Some say the two are a mild, limited form of colitis. Others argue that they are a completely separate disease. It has been shown that if the disease does not spread to the rest of the colon after six months, it probably never will. Furthermore, the prognosis for proctitis and proctosigmoiditis is better than the outlook for colitis.

Patients with the more limited disease rarely need to be hospitalized or treated with system-wide corticosteroids. Ulcerative proctitis is generally fairly mild. Since most of the colon is not affected, normal stools are usually formed. (In fact, a patient with the disease may even be constipated.) Treatment involves medication for the inflammation and hydrocortisone or corticosteroid foam enemas.

Dr. Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Bruckheim in care of this newspaper, P.O. Box 119, Orlando, Fla. 32802-0119.